【Abstract】Objective To evaluate the application of duct endoscopy in the diagnosis of breast diseases characterized by nipple discharge. Methods One hundred and sixtynine consecutive cases from October 2003 to September 2004 who had duct endoscopy for nipple discharge were reviewed and followed up. Results Of 169 cases, 79 ductitis, 62 intraductal papilloma, 9 intraductal carcinoma in situ, 19 without breast diseases were diagnosed under duct endoscopy. During following up, the diagnostic accuracy of intraductal papilloma and intraductal carcinoma in situ with duct endoscopy was 89.8%(44/49) and 55.6%(5/9),respectively. There was only one patient who had breast pain and mild skin redness which was cured with oral antibiotics for 3 days. Conclusion Duct endoscopy is an only technique to explore the etiology for duct discharge under vision. It is direct, safe and effective, with a high accuracy.
ObjectiveTo analyze the urinary catheter indwelling duration and its associated clinical outcomes in patients undergoing hepatobiliary and pancreatic surgery, so as to provide evidence for promoting early catheter removal practices and optimizing urinary catheter clinical management. MethodsThe data were retrospectively collected from patients who underwent surgery and had an indwelling urinary catheter in the Departments of Liver Surgery, Biliary Tract Surgery, and Pancreatic Surgery at West China Hospital of Sichuan University from January 1, 2023 to December 31, 2023. Multivariate logistic regression was used to analyze the risk factors for urinary retention and catheter-associated urinary tract infection (CAUTI) after urinary catheter removal, and multiple linear regression was used to analyze the factors influencing postoperative hospital stay. ResultsA total of 3 840 patients with indwelling urinary catheters were included, among whom the postoperative urinary catheter indwelling duration was <24 h (defined as early urinary catheter removal), 24–48 h, 49–72 h, and ≥72 h in 1 243 (32.4%), 1 678 (43.7%), 572 (14.9%), and 347 (9.0%) patients, respectively. The highest rate of early urinary catheter removal was observed in patients undergoing biliary tract surgery [52.1% (164/315)], and the lowest rate was observed in those undergoing pancreatic surgery [9.6% (102/1 064)]. Among the 3 840 patients with indwelling urinary catheter, urinary retention occurred in 213 (5.5%), CAUTI in 64 (1.7%), and urinary catheter reinsertion in 202 (5.3%). Multivariate logistic regression analysis showed that the risk of urinary retention was higher after pancreatic surgery and liver surgery compared with biliary tract surgery (OR=3.869, P=0.001; OR=2.425, P=0.017, respectively), and the risk was also higher in patients with operative time ≥180 min than in those with operative time <180 min (OR=1.537, P=0.003). Patients with urinary catheter indwelling duraion of 24–48 h, 49–72 h, or ≥72 h had a lower risk of urinary retention compared with those with early urinary catheter removal (OR=0.398, P<0.001; OR=0.177, P<0.001; OR=0.452, P=0.003, respectively). Independent risk factors for CAUTI after catheter removal were identified as urinary catheter reinsertion (adjusted OR=7.643, P<0.001), age 65–74 years and ≥75 years (using <45 years as reference; adjusted OR=4.708 and 7.201, P=0.006 and 0.002, respectively), female (adjusted OR=1.972, P=0.009), operative time ≥180 min (adjusted OR=2.317, P=0.003), and urinary catheter indwelling duration of 24–48 h, 49–72 h, and ≥72 h (using <24 h as reference; adjusted OR=3.328, 4.196, and 20.794; P=0.018, 0.013, and <0.001, respectively). Urinary catheter reinsertion, pancreatic surgery (using biliary tract surgery as reference), operative time ≥180 min, and prolonged urinary catheter indwelling duration (24–48 h, 49–72 h, and ≥72 h compared with <24 h) were associated with prolonged mean postoperative hospital stay (unstandardized coefficients were 2.089, 1.024, 1.536, 0.820, 0.878, and 1.244, respectively; all P<0.001). ConclusionsPostoperative urinary catheter indwelling duration in patients undergoing hepatobiliary and pancreatic surgery differs from guideline recommendations, and early removal might increase the risk of urinary retention. Early catheter removal should be implemented clinically while minimizing the risk of urinary retention.
ObjectiveTo explore the feasibility strategy for patients’ fast track after the operation of thyroid papillary carcinoma with no drainage tube application.MethodsPatients undergone the operation of thyroid papillary carcinoma from June 2017 to March 2018 were enrolled in this retrospective study. All patients were from the same medical teams composed with the same attending doctors. They were divided into two groups according to the drainage tube applied or not. Finally the incidence of postoperative hematoma, incisional infection, and subcutaneous effusion were compared between the two groups, while the length of stay, pain score after operation, and satisfaction of patients were also analyzed.ResultsThe incidences of postoperative hematoma, incisional infection, and subcutaneous effusion were totally similar between the two groups. While the length of stay and pain score were significantly shorter or lower, satisfaction of patients were higher in group of no drainage tube applied (P<0.05).ConclusionsThe operation of total thyroidectomy plus bilateral central lymph node dissection for papillary thyroid cancer without drainage tube will not increase the probability of complications such as hematoma, incisional infection and subcutaneous effusion. On the contrary, it can shorten hospitalization time, reduce wound pain and improve patient satisfaction in the concept of rapid rehabilitation.
Objective To observe the effectiveness of IMPACT management mode on self-care and management abilities of breast cancer patients undergoing chemotherapy with implantable venous access port (VAP). Methods Breast cancer patients who underwent chemotherapy with VAP at Shangjin Hospital, West China Hospital, Sichuan University between March 2020 and June 2021 were prospectively included. IMPACT mode was used for self-management training guidance. The patient self-care abilities before training and at 1 month, 2 months, and 3 months of training were compared, and the patient self-management abilities at 1 month and 3 months of training were compared. Results A total of 74 patients with breast cancer undergoing chemotherapy with VAP were included. The total score of self-care ability of patients before training and at 1 month, 2 months, and 3 months of training was 112.11±14.63, 123.20±15.73, 127.95±13.89, and 131.92±13.60, respectively, and all the between-time-point differences were statistically significant (P<0.05). In terms of self-concept score, all the between-time-point differences were statistically significant (P<0.05) with increasing score over time, except the difference between the score at 3 months of training and that at 2 months of training (P>0.05). In terms of self-responsibility and self-care skill scores, all the between-time-point differences were statistically significant (P<0.05) with increasing scores over time, except the difference between the score at 2 months of training and that at 1 month of training (P>0.05). In terms of health knowledge level, the scores at 1 month, 2 months, and 3 months of training were higher than that before training (P<0.05), and the score at 3 months of training was higher than that at 1 month of training (P<0.05). The self-management ability scores in all dimensions at 3 months of training were higher than those at 1 month of training, and the differences were statistically significant (P<0.05). Conclusion The IMPACT management mode can effectively improve the self-care and management abilities of breast cancer patients undergoing chemotherapy with VAP, thereby ensuring the normal use of VAP, reducing the occurrence of complications, and reducing the burden on families and society.
ObjectiveTo evaluate the safty of recurrent laryngeal nerve (RLN) and parathyroid if Pseudomonas aeruginosa injection (PAI) is used after total thyroidectomy and central neck dissection (CND).MethodsFrom Mar. 2016 to Oct. 2017, we recruited 113 patients with papillary thyroid cancer (PTC) who accepted total thyroidectomy and CND. During operation, 1 mL of PAI was applied in 58 patients (local spray group) and 55 not (control group). The hoarseness, hypoparathyroidism, chylous fistula, drainage volume, hospital stay, and incidence of complications were compared between the two groups.ResultsThe two groups embraced few difference in age, gender, BMI, tumor site, the diameter of tumor and the number of metastatic and the harvested lymph nodes (P>0.05). There were nobody who has suffered in hoarseness and permanent hypoparathyroidism in both groups at any time after operation. There was no significant differences of complication between the two groups. The drainage volume at 24 h after operation in the local spraying group was more than that in the control group, and the difference was statistically significant (P=0.023). There were 2 patients had chylous fistula after surgery in the control group but none in the local spray group. The total volumes of drainage, incidence of fever and incision infection, the mean stay in the hospital, and the postoperative pain score had no statistic significance in the both groups.ConclusionAfter total thyroidectomy and CND, local spraying of PAI in the wound cavity is safe and will not damage the recurrent laryngeal nerve.